Lack of Effectiveness of Syndromic Management in Targeting Vaginal Infections in Pregnancy in Entebbe, Uganda

The researchers conducted the current study to measure the prevalence of reproductive tract infections during pregnancy in Entebbe, Uganda, and to evaluate the current syndromic diagnosis and management approach in effectively targeting infections such as bacterial vaginosis (BV) and trichomoniasis that are associated with low birth weight and premature delivery among newborns.

The authors enrolled 250 attendees of antenatal clinics. They took vaginal swabs and performed diagnostic tests for BV, Trichomonas vaginalis (TV), candida, Neisseria gonorrhoeae, Chlamydia trachomatis, HIV-1 and active (TPHA+/RPR+) syphilis infection. Same-day treatment was offered for symptoms according to syndromic management guidelines. Treatment provided by health care workers was documented. The researchers used sensitivity, specificity, positive and negative predictive values to assess the effectiveness of syndromic management guidelines and practice.

Infection prevalences were: BV 47.7 percent, TV 17.3 percent, candida 60.6 percent, gonorrhea 4.3 percent, chlamydia 5.9 percent, syphilis 1.6 percent and HIV 13.1 percent. A total of 39.7 percent of women with BV and 30.2 percent of those with TV were asymptomatic. The sensitivity of syndromic management as applied by health workers in targeting BV and TV was 50.0 percent and 66.7 percent respectively, which would have increased to 60.3 percent (BV) and 69.8 percent (TV) had the algorithm been exactly followed.

"The prevalence of BV and TV seen in this and other African populations is high," the authors concluded. "High rates of asymptomatic infection and a tendency of healthcare workers to deviate from management guidelines by following their own personal clinical judgment imply that many vaginal infections remain untreated. Alternative strategies, such as presumptive treatment of BV and TV in pregnancy, should be considered."

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